For 20 years, nursing has been ranked as the most trusted profession in national Gallup polls. However, nurses make mistakes from time to time.
A new report from professional liability insurer Coverys provides insight into the types of errors that lead to medical malpractice claims. The carrier found that patient monitoring, medications, patient falls and bedsores were responsible for more than three-quarters of claims.
Susan L. Montminy, director of risk management, said Coverys decided to take a deep dive into the data relating to nurses’ involvement in malpractice lawsuits because the profession has been through a storm in the past few years: burnout caused by the difficulties of coping with the pandemic, learning failures and training, staffing shortages, limited budgets and a cultural shift, including an increase in the use of field nurses for temporary jobs.
The report includes recommendations on how to avoid nursing mistakes.
“We’re not trying to point fingers,” she said. “These are signals. This is a warning that alerts them to vulnerabilities. These are hypotheses. It’s really a call to action.”
The analysis showed that nurses are a relatively small part of the malpractice problem. According to the report, although nurses make up 56% of healthcare workers, they were only involved in 18% of claims, representing 26% of reimbursement. Doctors, by contrast, were involved in 50% of the lawsuits.
Monminy, herself a registered nurse, said nurses’ close relationship with patients may be why they are less likely than other healthcare professionals to be involved in allegations of poor care. “They are the face of care,” she said.
Doctors, on the other hand, are more distant figures. They are often seen as “ship captains”, hence they are more likely to be blamed when something goes wrong.
The high regard for nurses is reflected in Gallup’s annual Integrity and Ethics Survey. In the latest survey, conducted last December, nurses were rated highly or very highly by 81% of respondents. This is far more than doctors, who came in second at 67%, and primary school teachers, at 64%. According to Gallup, nurses have been leading the polls for 20 years.
But when mistakes are made, the results can be fatal.
Coverys assessed 4,634 events that led to medical malpractice claims that were closed from 2018 to 2021. The researchers identified 850 specific events where nurses were directly involved in care that led to the alleged medical error.
Death was the result of 37% of these events. Another 10% resulted in a serious disability such as blindness or paraplegia.
- Patient monitoring was involved in 45% of cases leading to complaints of malpractice, with death leading to these cases in 49% of cases.
- Drug administration and administration accounted for 18% of malpractice cases. Death occurred as a result of 39% of the alleged errors.
- Patient falls accounted for 14% of medical errors, with 41% of these falls resulting in death.
- Pressure ulcers were the source of 10% of medical malpractice claims, with 56% of these cases occurring in long-term care or advanced care facilities. Death occurred in 52% of cases.
Coveris said the data shows that comprehensive information is critical to preventing mistakes in patient care. Poor results often occur when nurses do not have detailed information about a patient’s medical history. Comorbidities such as dementia or heart disease were present in 80% of cases associated with patient care, patient falls, and work pressure, and 75% of cases associated with medication.
Vigilance is needed. Nursing requires multitasking and good work processes. Distractions and emergencies, combined with a heavy workload, can lead to errors.
Nurses should be encouraged to speak up when they have concerns or when they know they have made a mistake. Patient safety is enhanced when teams are not afraid of retaliation or blame for reporting errors.
Effective teamwork is also important. Nurses are the eyes and ears of healthcare. Their collective vigilance is essential for effective patient monitoring.
To improve patient monitoring, healthcare professionals can use monitoring algorithms to help nurses assess for signs of deterioration, Coverys says. Montmini explained that scoring systems can be used to send alerts when vital signs such as temperature or blood pressure deteriorate. They must be combined with a sound governance policy that provides concrete steps to resolve conflicts.
Technology can help reduce treatment errors. The report states that most errors occur in stationary conditions. Medicine dispensing cabinets must be reconfigured to require at least the first five letters of the medicine’s name to be entered when ordering medicines. Personnel should be trained to optimize the use of the security features built into electronic health records and medical equipment. In addition, health facilities should establish “no break” rules for nurses while they are on medication.
To prevent falls, healthcare facilities should use a standardized fall risk assessment tool to identify high-risk patients on admission. Nurses should not place too much confidence in the equipment. Devices such as handrails and restraints that are used to prevent falls can also increase the risk of fall injury because patients can become caught or entangled in these devices.
Pressure ulcers can be avoided if patients undergo a head-to-toe skin examination on admission and at regular intervals during their hospital stay. All medical staff should be trained in how to avoid pressure ulcers.
Most of the cases that led to malpractice complaints involving nurses had one or more risk issues, the report said; failure to function as a cohesive clinical team, miscommunication between doctor and nurse, cultural or organizational vulnerabilities, failure to provide a safe environment through adequate staffing or workplace design, and distractions that cause a lack of situational awareness.
Making nurses safer requires recognizing that vulnerabilities exist,” said Marianne Small, senior director of risk management and analytics at Coverys, in a video accompanying the report. “And where there are vulnerabilities, there is room for improvement.”
The report may be downloaded here.
About the photo: Nurses work in the emergency room at NYC Health + Hospitals Metropolitan, Wednesday, May 27, 2020, in New York City. Coveris said the pandemic has led to shortages, interruptions in training and burnout for nurses, which has increased the chance of making mistakes that threaten patient safety. (AP Photo/John Mincillo)